When death is certain, but dignity is not

A photo of Tony and Grace Lopez on their wedding day, taped on the wall over Tony's bed in a nursing home.

A photo of Tony and Grace Lopez on their wedding day, taped on the wall over Tony's bed in a nursing home. (Steve Lopez, Los Angeles Times)

Last time I wrote about my dad, he'd taken a fall in his bedroom, couldn't get up, but didn't want yet another ride in an ambulance. So my mother got down on the floor with him, pulled up a blanket and they went to sleep.

This time they went down together, falling in the street outside a Burger King in the Bay Area town of Pittsburg. He was using a walker with my mom assisting, but he lost his balance and dragged my mother down with him.

She was OK, but my dad was hurting. An ambulance happened to be going by, scooped him up and the verdict in the emergency room was a broken hip.

For a senior, those two dreaded words — "broken hip" — are often the beginning of the end. Doctors said that without surgery, my father would probably die within three months. But surgery itself could kill him, given his weak heart.

Because of the morphine and dementia, it wasn't clear that my father understood his options. The family decision was to go ahead with surgery, and when I flew north and walked into my dad's room, he was awake and surprisingly alert. I asked how he felt and he flexed his bicep. Two weeks later, he's recovering at a nursing home in the very room his older brother was in before his death — the room my dad did not want to ever visit again.

This is everyone's experience, sooner or later. The details vary, but not the endings. In the mail I've gotten since writing on this topic, several themes keep coming up:

• Every family should discuss end-of-life directives and power of attorney issues long before a loved one is on a deathbed.

• We have to debate the cost and humanity of keeping people alive for the sake of more suffering.

• Though most people fear death, they fear suffering even more.

• There's no shortage of elders in California who wish we had something like Oregon's Death With Dignity Act, which allows terminally ill patients to take their own lives with lethal medication prescribed by a physician.

"Being an 88-year-old retired physician, I know about this business of dying," wrote a gentleman named Harry, who has been married for 62 years. "We both have advised our children we shall not have extensive life support, but choose to leave in the natural way. It is greatly important to discuss this problem which has several components. One is the high cost of medical care for us old folks.

"My sister-in-law is 91 with severe dementia and in an assisted-living facility. Her HMO physician insists that she have a mammogram at least once each year, and when she coughs or has a fall she is always rushed to the ER for extensive treatments … numerous families insist on everything for Granny, regardless of the cost."

"I'd love to be as lucky as my mother was and spend my last day on Earth having lunch, getting a manicure and pedicure, eating dinner and then quietly closing my eyes and dying.… Why California can't be as enlightened as Oregon, I can't fathom!"

And a reader named Doug had this to say:

"My mother is 103 and has severe dementia. Quality of life is zero. She is DNR [do not resuscitate], yet still the Medicare money pours out. Emergency room visits. Home healthcare, hospice, expensive drugs. To say nothing of the $6,000-a-month 'memory care' giving."

Lots of readers responded to my column on Polly Berger, 86, who said she's tired of aches and pains and would like to die in her sleep before her children have to take care of her as if she were a child again. Robert, 96, wrote to say that he and his wife of 70 years, Nancy, "Are ready for the end.… Like Art Linkletter said, the day we wake up without an ache or a pain, we will know we are dead."

"I am dealing with metastasized cancer that went to my liver, lungs and backbone," wrote a reader in Canoga Park. "It was caught early enough so that five brutal chemotherapy treatments later, I am stable. I know this will eventually kill me and even though I don't fear death, dying from liver failure or any slow-moving disease petrifies me. So why is it anyone's business if some pills were made available so I could finish the job a little sooner?"

Roxanne wrote to say that although she's 80 and healthy, she and her friends talk about what they'd do if and when someone tries to ship them to a nursing home.

"The consensus was we would attempt to end it all, be it pills combined with booze or a gun, it wasn't clear … the fear was not having control of our faculties."

Another reader, name withheld, said this:

"You'll be with me as I visit my widowed dad at an Alzheimer's facility where, unlike your dad, he's trying to find a way to commit suicide. 'If I could only die, I'd be so happy,' he says."

Gene Dorio, a geriatric physician whose practice consists almost entirely of house calls in Santa Clarita, says it's time for Baby Boomers in our rapidly aging society to talk about policy reforms around death and dying. So I drove up to chat with Dorio, who thinks we can cut healthcare costs even as we die with less suffering and more dignity.